The crisis of the social care workforce

Andy Whittingham is the National Audit Office value for money lead on adult social care

Last month the National Audit Office – the body that aims to improve public services through scrutinising public spending and helping Parliament hold government to account – published a report on the adult social care workforce in England.

Despite nearly 1.5 million people working in adult social care in England, and billions of pounds of public money spent on the sector, we concluded that the Department of Health and Social Care (DHSC) is not doing enough to support a sustainable social care workforce and needs to take action before the situation worsens. Since then, Parliament’s Public Accounts Committee has held a session on this topic, quizzing DHSC about its plans to address the issues raised in the report. So, what problems did we identify, and what is the government planning to do?

Our report found that there is not enough recognition of how important social care is and how it transforms people’s lives for the better. Social care is often seen as subsidiary to the health service, and the care workforce is undervalued and poorly rewarded. This is leading to high turnover and unfilled posts. It was therefore good to hear that DHSC, with Skills for Care, is planning a national recruitment campaign to change the public’s views around working in care, overturning the perceptions that it is low skilled, unrewarding and with limited opportunities for career progression.

It was also encouraging to hear that DHSC recognises that the UK’s departure from the EU could have a significant impact on the care workforce. It is working with the Home Office on taking into account the needs of the care sector as future immigration policy is developed.

We also highlighted that care providers are experiencing increasing difficulty recruiting and retaining staff. Low pay is one of the biggest causes of this. In 2016-17, around half of care workers were paid £7.50 an hour or less, equivalent to a full-time annual salary of under £15,000, which puts off workers from joining and remaining in the sector. Local authorities, which commission most care from 20,300 independent providers across England, spent 5.3% less on care in 2016-17 than in 2010-11. The workforce is not growing fast enough to meet the country’s increasing care demands. It is widely acknowledged that many more people will need care in the future, and their needs will become more complex. DHSC estimates that the workforce needs to grow by 2.6% each year to meet this need.

Around two-thirds of independent providers’ income comes from local authority arranged care. The vast majority of local authorities pay fees to homecare providers below the recommended minimum price for care, putting some in financial difficulties. Furthermore, local authorities are not paying the full cost for care home placements. If this continues, there is a risk that providers will not invest in areas with high numbers of people receiving local authority funded care.

Encouragingly, DHSC acknowledges that the care sector faces significant financial pressure and requires future investment. The government intends to publish a Green Paper on funding and reforming care for older people by summer 2018, and there is a parallel piece of work being developed on care for working-age adults. These proposals, which have been postponed several times, are eagerly awaited across the sector. This is the government’s opportunity to recognise the vital role of care workers and urgently address the challenges we, and many others across the sector, have highlighted.